Provider Demographics
NPI:1104986322
Name:TRINIDAD, DIANOLIS
Entity type:Individual
Prefix:
First Name:DIANOLIS
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORRE A OFICINA 608
Mailing Address - Street 2:METRO MEDICAL CENTER
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-395-7125
Mailing Address - Fax:787-395-7126
Practice Address - Street 1:TORRE A OFICINA 608
Practice Address - Street 2:METRO MEDICAL CENTER
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-395-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15068207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease